stable INR

[SV2004]

Hi everyone

Have been reading but not writing much for the last few weeks. I am 3 weeks post-op. I feel better. Pain has reduced a lot though I am taking extra strength Tylenol 2-3 times a day.

I am struggling with unstable INR. My cardiologist told me that the INR range is 2.5 to 3.0. I am either low or high. How long did it take for folks on Coumadin to reach this range and stayed it that way? I am giving blood twice a week now.

 

[Ross]

If they are testing you twice a week, I suspect they don't know how to manage Coumadin though there may be other reasons for the frequent testing.

My first question would be, How are they dosing you? Amounts, days, etc?
Second, what meds are you on now?
Third, tell me about your diet?

At first, it seems to take about 1 to 3 months to get it to settle since your activity keeps increasing, along with changes and dropping of some medications.

 

[SV2004]

Hi Ross

Last week, I was on 5mg on Mon,wed, Fri and 2.5mg rest of the days. This week, they asked me to take 5mg for 6 days and 2.5mg one day.

Right now, I am taking ES tylenol and levoxyl (for thyroid)
Coming to diet, I am a vegetarian and trying to maintain a consistent diet. No leafy veggies, cabbage, broccoli.

thanks
Sree

 

[McCln]

Unstable numbers

Unstable numbers

Well, here is an update on my perplexed problem. I have horrible readings of 1.9 for the past month. Just last Thursday, it shot up to 4.1. Went to make another deposit today. I hope to have a better result. I remember the posts suggesting that maybe increase activity maybe a culprit. No one has said nothing that that is wrong. And the nurse said that usually in the spring and summer, there are irregular readings with increased activity and changing eating habits. So, when I am not too tired, I will be back with the latest results. Wish me luck and wish everyone luck on theirs. Take care.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve

 

[Ross]

I think your just caught in the recovery cycle and it's going to take some more time. Don't cut out the necessary vegetables in your diet. Eat them and let the Coumadin be adjusted for it. I can understand wanting it to get level before doing so, but please, don't deprive yourself or your body of the needed nutrients. Your meds and activity level will play a large part in this also. I still think they are testing too frequently, but that may be because of the thyroid med too.

 

[Guest]

If you wait until your INR is in the therapeutic range to start eating more vegetables then you are just going to throw the INR off again.

Another thing that will make your INR hard to manage is the narrow range that your doctors have set for your INR. The American College of Chest Physicians recommends 2.0 to 3.0 or 2.5 to 3.5. Using a driving analogy, what is it easier to do, keep your spped between 25 and 35 or 25 and 30? There is no bettwe outcome with a narrow range. All it does is adversely affect your quality of life because you are always getting blood tests and dosage changes. In my clinic people have major bleeds about once every 33 patient years. Your doctor has failed to take this into consideration. Does (s)he think that they can improve this to 66 patient years with a narrower range? It is more likely that it will be 33.1 patient years. Is this really a significant outcome given all of the extra testing that is required to stay in such a narrow range?

McCln 4.1 isn't really shooting up. I'm more happy when my patients have a 4.1 than a 1.9 if their range is 2.5 to 3.5. Somebody would have to have a 4.1 for about 3 months in a row before I would consider adjusting their dose. The consequences of being slightly high are almost always less than being even a little bit low. Better to risk a bloody nose than a needing a new valve or being paralyzed.

 

[JimL]

Sree, if I understand your numbers correctly, you were taking 25mg coumadin a week, and you were increased to 32.5mg a week, which I would count as a 30% increase in dosage. Unless you are wildly out of range, that's too much of a change; the normal change is about 10%, which would have been a change from 5mg three days a week to 5mg four days a week, and 2.5mg the rest of the days. I normally adjust my dosage up or down 1mg per week, which keeps me in range, most of the time anyway.

 

[Karlynn]

Sree,
Glad you are feeling better.

Eat how you normally would eat. If you eat lots of dark green vegies, I'd cut back on those if you think you can, simply because you'll end up taking a lot of Coumadin to keep in range. But your Coumadin needs to be adjusted to how you will eat when you are feeling well and not thinking about the fact that you've had a valve replacement.

2.5 to 3 is a tight range and you will find that your doctor is doing a lot of adjusting of your meds to keep it in that tight range.

Keep educating yourself with Al Lodwick. www.warfarinfo.com Al is, by far, the best thing that has happened to me as far as understanding and managing my life on Coumadin.

 

[McCln]

Hey everyone, including Al

Hey everyone, including Al

Well, INR went down to 2.8, hope it stays stable for the next visit. I go back next week for another pt. And please for the new people, keep stable in your diet. I have never ate vegitables regularly for years and any change is great. Just hang in there and stability will come, mine will soon.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve